Tag Archives: Obamacare

Ever since President Donald Trump won the White House, Democrats, interest groups, and even some Republicans have argued that rolling back Obamacare would harm the health of millions. But a new study published in the National Bureau of Economic Research suggests Obama’s healthcare law does little to actually improve patient’s health outcomes.

The research shows that while Obamacare expanded patient access to doctors, nurses, and hospitals, it’s provided little-to-no actual health benefits. The authors analyzed data from the Behavioral Risk Factor Surveillance System, an annual medical survey conducted by the Centers for Disease Control. After two years of observations, survey respondents reported they enjoyed greater access to health insurance, primary care, and routine check-ups. Yet the authors observed almost zero overall improvement in physical health after the patients got covered by Obamacare.

Other studies have come to similar conclusions. After Oregon expanded their Medicaid program through a lottery in 2008, researchers at the Massachusetts Institute of Technology compared the health of individuals selected to enroll in Medicaid versus those who remained uninsured. After two years, they observed Medicaid recipients visited the doctor more, utilized more preventive care, and consumed more prescription drugs. But they saw no improvement in blood pressure, cholesterol, or blood sugar relative to the uninsured. Medicaid enrollees even visited the emergency room more frequently.

Since the ignominious failure of the Obamacare repeal effort, President Trump has been lashing out at the Republican House Freedom Caucus on Twitter. “The Freedom Caucus will hurt the entire Republican agenda if they don’t get on the team, & fast,” he tweeted in a remarkable threat to members of his own party. President Trump’s frustration with legislative obstruction overlooks the fact that that obstruction is itself one of the greatest strengths of the American system of government.

The beauty of the American system is that it enables not only members of opposition or minority parties like today’s congressional Democrats, but also members of governing or majority parties, to curb executive power. What happened last month was an example of that phenomenon. Unlike the way things work in British-style parliamentary systems like that of my home country of Canada, with their fusion of the executive and legislative branches of government, Congress is elected separately from the president. Members of both chambers of Congress are accountable primarily to their constituents at the ballot box rather than to party leaders.

Republicans in the House were thus free to resist whatever pressure the Trump White House and Speaker of the House Paul Ryan exerted on them to vote for the American Health Care Act (AHCA). Contrary to the president’s incensed tweets, the AHCA went down to defeat not only thanks to the House Freedom Caucus, but also thanks to the so-called “Coverage Caucus” of more cautious Republicans who balked at the prospect of depriving millions of their constituents of health insurance. Freedom Caucus members and their allies refused to support the bill because it was not enough of a departure from the Affordable Care Act for them; “Coverage Caucus” Republicans opposed it because, in effect, it was too much of a departure from Obamacare.

While President Donald Trump’s efforts to repeal and replace Obamacare have dominated the news, he also plans to reform a larger and arguably more broken program: Medicaid. In an interview with NBC’s “Today” show, Trump advisor Kellyanne Conway said Trump wants to “block-grant Medicaid to the states” to ensure “those who are closest to the people in need will be administering.”

Conway’s comments echo Trump’s campaign promise to “maximize flexibility for states via block grants so that local leaders can design innovative Medicaid programs that will better serve their low-income citizens.” Block grants would cap federal Medicaid funding and let states decide how to use those dollars. It would introduce flexibility and budget discipline to a program that sorely needs both.

Medicaid Soaks Money Away From Other Priorities

Since its inception in 1965, Medicaid has operated as an open-ended entitlement. The more state Medicaid programs spend on health-care programs for designated recipients, the more the federal government reimburses them. On average, states receive $1.33 for every $1 they spend on Medicaid.

While Medicaid’s current framework sounds like a generous deal for states, Medicaid’s funding formula incentivizes policymakers to expand the program at the expense of core state government functions. A report by the Mercatus Center shows that as Medicaid’s share of state budgets grow, state spending on roads, schools, and public colleges shrink.